Zika Virus Update

04/26/2016

Healthy Living - April 26, 2016
Garrick Slate, MD
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What do we know?

 
Zika is a mosquito-borne virus that has been associated with congenital microcephaly (abnormally small head and potential damage to the fetal brain). Current research by the CDC demonstrates a relationship between the Zika virus and microcephaly. CDC director, Thomas Frieden, MD, MPH has said: “Never before in history has there been a situation where a bite from a mosquito could result in a devastating malformation”
 
Zika is also associated with several neurologic (nerve) disorders including Guillain-Barre Syndrome (autoimmune paralyzing illness) and an autoimmune syndrome called acute disseminated encephalomyelitis which resembles multiple sclerosis and is found mostly in children.
 
Symptoms:
 
Most commonly: rash, fever, joint and muscles aches (small joints of hands and feet mostly) and eye inflammation. However, only 1 in 5 people (20%) will develop symptoms. The remaining 80% will never develop symptoms – but this does NOT mean that they have not contracted the virus (become infected).
 
Transmission:
 
Most common mode of transmission is from a mosquito bite from a mosquito who has previously bitten an infected person.
 
Now two species of mosquito are known to transmit the virus (Aedes aegypti and Aedes albopictus)
 
However; we now have evidence of sexual transmission of the virus from an infected person to their partner. Male to female and male to male transmission is now documented.
 
Maternal to fetal (across the placental), Blood transfusion, organ transplantation and laboratory exposure.
 
Zika virus RNA has been detected in blood, urine, semen, saliva, cerebrospinal fluid, amniotic fluid and breast milk. In blood virus is detectable from a few days to a week, BUT has been detected during pregnancy for as long as 10 weeks. Detection is longer in urine and semen (up to 62 days after symptom onset when no longer detected in the blood)
 
 
Where is the virus found?
 
Central and South America
Mexico (less risk of transmission above 6500ft elevation)
Caribbean and Puerto Rico
Africa (Cape Verde)
Pacific Islands / Oceania (American Samoa, Samoa and Tonga)
 
What to do from a patient perspective?
 
  1. Inform your healthcare provider if you have visited any of the areas above within the last three weeks.
  2. All pregnant women need to inform their obstetric provider and be tested regardless of symptoms.
  3. If a male partner has traveled to an affected area he should be tested first and the couple should not engage in ANY personal relations/sexual contact.  If male partner tests positive then the female partner needs to be tested.
  4. If a male partner has traveled to an affected area CDC recommends abstinence or use of condoms for duration of pregnancy.
  5. For male partners returning from areas affected by  Zika transmission to areas of non-transmission:
    1. If symptomatic infection (confirmed or suspected) – couple should wait at least 6 months before having unprotected intercourse
    2. If asymptomatic infection – couple should wait at least 8 weeks before unprotected intercourse.
    3. If partner or partners were in affected area and want to conceive they should wait at least 8-12 weeks before any sexual activity or see their physician to get blood testing prior to attempting pregnancy.